OxfordAQA IGCSE Psychology: Mental Health, OCD and PTSD (9218)

3.2.3 Mental health is the third topic of Paper 2 (Social Context and Behaviour) in OxfordAQA International GCSE Psychology (9218), Version 1.1. It covers why the incidence of significant mental health problems changes over time, the effects of those problems on individuals and society, and two named disorders — obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) — each with its ICD diagnosis, explanations, a therapy and a named study of that therapy’s effectiveness.

Syllabus coverage

OXFORDAQA INTERNATIONAL GCSE PSYCHOLOGY (9218) — 3.2.3 MENTAL HEALTH

• How the incidence of significant mental health problems changes over time: characteristics of mental health; cultural variations in beliefs about mental health problems; increased challenges of modern living (for example isolation); increased recognition of mental health problems and lessening of social stigma
• Effects of significant mental health problems on individuals (damage to relationships, difficulties coping with day-to-day life, negative impact on physical wellbeing) and on society (need for more social care, increased crime rates, implications for the economy)
• OCD: use of the International Classification of Diseases (ICD) in diagnosis; characteristics of obsessions and compulsions; biological and cognitive explanations; cognitive behaviour therapy; Kearns’s study of the effectiveness of CBT for OCD
• PTSD: use of the ICD in diagnosis; characteristics; biological factors and dual representation theory; prolonged exposure therapy; Eftekhari’s study of the effectiveness of prolonged exposure therapy

Why does the incidence of mental health problems change over time?

Good mental health is more than the absence of illness. The specification gives characteristics of mental health such as positive engagement with society and effective coping with challenges. Recorded rates of significant mental health problems rise and fall for several reasons:

• Cultural variations in beliefs. Whether a pattern of behaviour is seen as a mental health problem, a spiritual matter or a normal reaction varies between cultures and over time, which changes what gets reported and diagnosed.
• Increased challenges of modern living. Features of modern life such as isolation — living alone, moving away from family, or relying on online rather than face-to-face contact — may raise the real rate of problems.
• Increased recognition and less stigma. As people understand mental health problems better and feel less ashamed, more people seek help and more cases are diagnosed. Some of the rise in recorded incidence may therefore reflect better recognition rather than more illness.

What effects do mental health problems have?

On individuals	On society
Damage to relationships with family and friends	Need for more social care and health services
Difficulty coping with day-to-day life, such as work or study	Increased crime rates in some cases
Negative impact on physical wellbeing, such as sleep, diet and illness	Economic costs: lost working days, lower productivity, cost of treatment

How is OCD diagnosed and explained?

Diagnosis with the ICD. The International Classification of Diseases, published by the World Health Organization, lists the features a clinician looks for. Obsessions are persistent, unwanted and intrusive thoughts, images or urges (for example about contamination or causing harm) that cause anxiety. Compulsions are repetitive behaviours or mental acts (such as washing, checking or counting) carried out to reduce that anxiety or prevent a feared event. For a diagnosis, the obsessions and/or compulsions are recognised as the person’s own, are time-consuming or cause significant distress, and interfere with daily functioning.

Biological explanations. OCD tends to run in families, and concordance is higher for identical than non-identical twins, suggesting a genetic influence. Neurochemical explanations link OCD to low levels of serotonin, supported by the fact that drugs which increase serotonin reduce symptoms for many patients. Neural explanations point to unusual activity in brain circuits involving the frontal lobes, which may make it hard to stop worrying thoughts.

Cognitive explanations. People with OCD may have faulty thinking: they overestimate the likelihood of danger, feel excessive responsibility for preventing harm, and treat having a thought as if it were as bad as acting on it. Trying to suppress intrusive thoughts makes them more frequent, and the compulsion is kept going because it briefly relieves the anxiety.

Therapy: cognitive behaviour therapy (CBT). CBT helps the person identify and challenge their irrational beliefs about threat and responsibility, and usually includes exposure and response prevention: the person is gradually exposed to the feared situation (such as touching a “dirty” object) and supported not to carry out the compulsion, so they learn the anxiety falls without it. Kearns’s study is the specification’s named investigation of how effective CBT is for OCD; learn its aim, procedure, findings and conclusion from your course materials and be ready to evaluate it as evidence for the therapy.

How is PTSD diagnosed and explained?

Diagnosis with the ICD. PTSD can develop after exposure to an extremely threatening or horrific event, such as war, assault or a serious accident. Characteristics include re-experiencing the event (intrusive memories, flashbacks or nightmares), avoidance of thoughts, places or people that are reminders of it, and a persistent sense of current threat (hypervigilance and an exaggerated startle response). The symptoms last for at least several weeks and cause significant impairment.

Biological factors. Some people may have a genetic vulnerability. Brain research links PTSD to an over-active amygdala (fear responses) and to the hippocampus, which places memories in their time and context. Stress hormones released during trauma may affect how the memory is stored.

Dual representation theory (Brewin and colleagues) proposes that traumatic events are stored in two memory systems. A verbal, contextual memory can be deliberately recalled and put into words. A sensory, situational memory holds the raw sights, sounds and feelings, and is triggered automatically by reminders. In PTSD the sensory memory is very strong and poorly linked to the contextual one, so it intrudes as a flashback that feels as though it is happening now.

Therapy: prolonged exposure therapy. Over a series of sessions the therapist explains how PTSD is maintained, then uses imaginal exposure (repeatedly recounting the trauma in detail) and in-vivo exposure (gradually approaching safe situations the person has been avoiding). Avoidance stops, the memory is processed, and anxiety reduces. Eftekhari’s study (Eftekhari and colleagues, 2013) examined prolonged exposure delivered by therapists trained in a national programme for United States military veterans, and found significant reductions in PTSD and depression symptoms after treatment — evidence that the therapy works outside tightly controlled trials.

Common mistakes

• Defining obsessions and compulsions the wrong way round: obsessions are thoughts, compulsions are actions.
• Saying rising incidence proves mental illness is increasing, without considering better recognition and reduced stigma.
• Describing a therapy without linking it to the explanation it targets (CBT challenges faulty thinking; prolonged exposure ends avoidance).
• Forgetting that each disorder has both a biological and a psychological explanation.

Frequently asked questions

What is the difference between an obsession and a compulsion? An obsession is an unwanted, intrusive thought, image or urge that causes anxiety. A compulsion is a repetitive behaviour or mental act carried out to reduce that anxiety.

What does dual representation theory say about flashbacks? That trauma creates a strong sensory memory that is poorly linked to a verbal, contextual memory. Reminders trigger the sensory memory automatically, so it is re-experienced as if happening now.

Why might recorded rates of mental health problems rise? Partly because of real pressures such as isolation, and partly because better recognition and less stigma mean more people seek a diagnosis.

Which therapies does the specification name? Cognitive behaviour therapy for OCD and prolonged exposure therapy for PTSD.

Related resources

• Communication and Mental Health revision notes
• Communication and Mental Health practice questions
• Communication study guide

Official syllabus

OxfordAQA International GCSE Psychology (9218) specification, Version 1.1, section 3.2.3 — oxfordaqa.com.